In February 2010, the FDA announced new controls for long-acting beta2
agonist (LABA)-containing drugs that may alter the asthma treatment
paradigm. Concerned about an increased risk of asthma-related death with
LABA-containing drugs, the FDA advises that fixed-dose combinations of
LABAs and inhaled corticosteroids (ICSs) be reserved for patients whose
asthma remains uncontrolled despite treatment with single-agent ICSs.
The revised guidelines have been an impetus for physicians to reevaluate
their reliance on LABA/ICS combinations to treat asthma.

It remains to be seen whether LABA/ICS combinations, which are
frequently used for first-line therapy, will continue to be used in this
manner. Indeed, many LABA/ICS combinations in development are no longer
expected to be launched in the United States given the burden of safety
trials now expected by the FDA for LABA-containing drugs.

This report examines patient-level claims data to quantify the use of
asthma maintenance therapies, including the LABA/ICS combinations
GlaxoSmithKline's Advair, AstraZeneca/Astellas's Symbicort, and Merck's
Dulera, as well as many single-agent ICSs. We determine the share of
each drug by line of therapy, evaluate the therapy flow, and analyze why
key drugs are chosen over others. We provide valuable insight for any
company looking to take advantage of the competitive openings resulting
from the increased concern surrounding LABA/ICS combinations.

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